2022 Healthcare Fraud, False Claims Act Settlements Exceeded $2B

Healthcare Fraud 2022

Citizen whistleblowers helped the U.S. Department of Justice (DOJ) resolve a near-record number of False Claims Act investigations in 2022, resulting in more than $2.2 billion in taxpayer funds recovered, according to a recent DOJ report.

“The government and whistleblowers were party to 351 settlements and judgments, the second-highest number of settlements and judgments in a single year,” the DOJ reported in February. “Recoveries since 1986, when Congress substantially strengthened the civil False Claims Act (FCA), now total more than $72 billion.”

“The large number of settlements and judgments this past year demonstrates that the False Claims Act remains one of the most important tools for ensuring that public funds are spent properly and advance the public interest,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the DOJ’s Civil Division.

The vast majority of recoveries involved healthcare fraud, with a reported $1.7 billion in taxpayer funds recovered, according to the report.

What Is the False Claims Act?

The origins of the False Claims Act date to the Civil War when Congress passed the law to deal with dishonest individuals and vendors who sold shoddy merchandise to the Union Army. Signed by President Abraham Lincoln in 1863, the law encourages citizens to report fraud against government agencies. Since then, the U.S. government has used the FCA to respond to fraud by imposing penalties on anyone who submits a false claim to a federal agency.

Congress increased the impact of the FCA in 1986 by providing more incentives — such as mandatory financial rewards that vary from 15 to 30 percent — for whistleblowers to file lawsuits alleging false claims on behalf of the government. Such legal measures taken by citizens are called qui tam actions. Congressional tweaks in 2009 and 2010 improved the whistleblower provisions.

Healthcare Fraud Is Widespread

Healthcare fraud remains the most common type of FCA whistleblower action. Medicare, Medicaid, and TRICARE (a health care program for service members and their families) all benefit when fraud is minimized.

In fiscal year 2022, FCA healthcare investigations uncovered abuses in the following areas:

  • Billing Medicaid/Medicare for unnecessary urine, genetic and psychological testing
  • Underpaying rebates to the Medicaid program
  • Provisioning of home health services to patients who are not homebound
  • Providing kickbacks to induce Medicare/Medicaid/Tricare patient referrals, including the use of copay subsidies and the payment of kickbacks to physicians in the form of speaker honoraria, speaker training fees, and opportunities to invest in testing labs

A Diversity of Fraud in Other Areas

FCA settlements in 2022 also included an assortment of recovered funds in other key areas of the government. Among them were:

  • Fraudulently inducing the U.S. military to pay contractual performance incentive fees that were not properly earned
  • Selling defective material to the military
  • Committing data security fraud by failing to maintain government records on secured networks as required by contract
  • False reporting by airlines regarding the timely delivery of government merchandise, including mail receptacles
  • Manipulation of small business set-aside contracts through the use of ineligible affiliated entities
  • Knowingly underpaying customs duties

Both corporations and individuals face substantial fines when found responsible for fraud against the U.S. government. In 2022, a doctor in Los Angeles was ordered to return $9.5 million for false claims to Medicare and Medi-Cal for procedures and tests that were not done. A Philadelphia psychiatrist was fined $3 million for submitting false claims to the Department of Labor’s Office of Worker’s Compensation Program for services that were not provided.

Whistleblowers Play Key Role in Fraud Recovery

In 2022, 652 qui tam whistleblower actions were filed – the equivalent of 12 new cases each week. Individuals who reported abuse and false claims received government rewards totaling more than $488 million.

“We are grateful for the hard work and courage of those private citizens who bring evidence of fraud to the department’s attention, often putting at risk their careers and reputations,” Boynton said. “Our ability to protect citizens and taxpayer funds continues to benefit greatly from their actions.”

How Do We Fight Fraud Against the Government? 

Seek justice on behalf of taxpayers with the help of our experienced attorneys. Our Dallas, Texas, whistleblower team has battled corporate giants for 20 years, aggressively fighting to hold corporations, individuals, and other entities accountable for fraud committed against the government. If you believe you have a whistleblower case, we can help.

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That’s the first question everyone asks. The truth is it’s impossible to know. But we can tell you this. Waters Kraus Paul & Siegel has what it takes to fight against big corporate interests and win. That’s why we’ve taken more mesothelioma trials to verdict than any other firm. And that’s why we’ve recovered more than $1.3 billion for clients like you. Do you think you have a case? Contact us now to speak with an attorney.

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